title: Treatment of acute myeloid leukemia with 20-30% bone marrow blasts.
abstract: The transition of patients with ≥20% <30% bone marrow (BM) blast from the FAB category of myelodysplasia to the family of acute myeloid leukemia (AML) according to the recent WHO classification has not resolved the argument as to whether the natural history and responsiveness to therapy of these diseases is comparable to that of AML with > 30% BM blast. These controversies are even more manifest when it comes to elderly patients in whom concern for intensive chemotherapy (IC) related toxicity is the critical determinant for the therapeutic choice. In fact, due to concerns of treatment-related morbidity and mortality associated with delivery of IC, approximately only 30% of all patients ≥65 years are considered eligible for this approach. Therefore, a great deal of attention has been dedicated to alternative agents such as hypomethylators (azacitidine and decitabine). Actually, these agents have shown efficacy with reduced toxicity when administered to elderly patients with 20-30% BM blasts and not eligible for IC. In the present review, we will discuss the clinical results achieved in the treatment of elderly patients with 20%-30% BM blasts AML using intensive chemotherapy (IC) or hypomethylating agents. Overall, our survey of the literature suggests that only controlled, randomized, clinical trials will answer the question as to whether hypomethylating agents has the potential to substitute for IC even in elderly patients with an optimal functional status.
authors.affiliation: Cattedra di Ematologia, Università "Tor Vergata", Roma, Italia.
authors.forename: Luca
authors.initials: L
authors.lastname: Maurillo
authors.forename: Francesco
authors.initials: F
authors.lastname: Buccisano
authors.forename: Maria Ilaria
authors.initials: MI
authors.lastname: Del Principe
authors.forename: Chiara
authors.initials: C
authors.lastname: Sarlo
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Caprio
authors.forename: Concetta
authors.initials: C
authors.lastname: Ditto
authors.forename: Federica
authors.initials: F
authors.lastname: Giannotti
authors.forename: Daniela
authors.initials: D
authors.lastname: Nasso
authors.forename: Eleonora
authors.initials: E
authors.lastname: Ceresoli
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Postorino
authors.forename: Marco
authors.initials: M
authors.lastname: Refrigeri
authors.forename: Sergio
authors.initials: S
authors.lastname: Amadori
authors.forename: Adriano
authors.initials: A
authors.lastname: Venditti